Tox on the web: 12 students hospitalized at Wesleyan College after “Molly” overdose

Four students arrested at Wesleyan College after “Molly” overdoses: Last weekend a dozen students and visitors at Wesleyan University in Middletown, Connecticut were hospitalized after apparently ingesting a drug or drugs labelled as “Molly.” Two victims were in critical condition and were medevacked to Hartford Hospital, the only Level 1 Trauma Center in the region. By mid-week, these two patients were still in hospital but reported to be improving. Four students have been arrested in connection with this incident.

As @forensictoxguy pointed out on his blog “The Dose Makes The Poison,” the reporting of this story on the media has been generally confusing. Some outlets described “Molly” as a pure potent form of MDMA (ecstasy), and reported that police attributed the extreme adverse effects to a “bad batch.” But as one official remarked, when it comes to “Molly” there is no such thing as a “good batch.” Users never no for sure what drug(s) their product contains; one report found that only 13% of “Molly” samples contained any MDMA at all. (And, of course, MDMA itself can be fatal.) Later statements from police indicated that the samples from Wesleyan contained several designer drugs.

Because of this uncertainty about what’s in the drug, using “Molly” has always been a form of pharmaceutical Russian Roulette. TPR has pointed this out before.

The Activated Charcoal Cleanse: Companies that make juice products intended for detox or cleanse programs are now offering a new type of product: drinks spiked with activated charcoal:

blackmagic_bottle_large

These would be great beverages to stock in the vending machine in emergency department waiting rooms. The drink pictured above is made with water, activated charcoal, lemon, Grade B maple syrup, and Himalayan sea salt. It is not clear how much activated charcoal one bottle contains. Of course, I’ve ordered some and will report back on a taste test when it arrives.

Podcast of the Week: ToxTalk has a great episode with Dr. Guy Weinberg (@lipidguy) discussing how the history of lipid rescue therapy progressed from clinical observation, to animal models, and then back to use in clinical medicine. There is also a little bit about possible mechanisms, a topic that will be continued in Part 2 that should be posted in the next several days. Highly recommended. To listen to Part 1, click here.

 

Getting testy: Parents who demand tests in the ED and doctors who may or may not order them

There are many demands in the emergency department. Perhaps the most important ones come from patients and their families. This post originally appeared on PEMBlog.com as a part of the Art of Medicine series and looks at those situations in which patients/parents are requesting – nay demanding specific tests. As I noted in a previous post in this series the ED is an emotionally charged environment. Often parents are seeking an answer as to why their child is ill. That answer may come in the form of a specific diagnosis or further elucidation as to the reason for particular symptoms. I’m sure that many of you have encountered a parents asking for a “test” to tell them what’s wrong with their child. Perhaps they’ve even asked for it by name. “I just want a CBC.” or “She needs an MRI.” Let’s explore this conundrum in a little more depth, shall we? Why are they demanding a test? Because they are scared. Sense a theme here? Coming to the ED is oftentimes a frustrating, terrifying experience. Uncertainty drives many a visit, and in order to mitigate concerns parents are seeking answers. In many ways we have been taught to seek out objective evidence. In an era where any test is possible parents may be conditioned to think that the only path to a diagnosis is through a confirmatory test. Empiricism this is not. So before getting that test explore why the parent is “demanding” it in the first place. I’ve found that it is frequently possible to convince the parent that your diagnosis is justifiable based on H&P and clinical reasoning alone. All that this takes is time. Before ordering any test you should answer the following questions: Is it justifiable based on the clinical scenario? Is it justifiable from a billing standpoint? Will it make a difference in the patient’s clinical care? Is the risk worth the potential benefit? Don’t they trust me? Unless they explicitly say so the answer to this one is no. Many patients have been to multiple providers/had multiple visits before coming to the ED. Keep that in mind, and you will better empathize with a certain degree of skepticism that surrounds select encounters. Also, know your limitations. It’s cliche for sure, but trust is earned. You should always be honest with the family about what you think is going on and why you need/don’t need to pursue testing. What if the referring physician said they should get a test, but you disagree or feel that a different test would be better? Let’s consider the example of a belly CT for abdominal pain. Sure, it’s a great imaging modality, but the risk of exposure to ionizing radiation is great. Remember that to work in the ED is to work in a place where the worst case scenario should be considered and ruled out. This begins with an appropriately thorough H&P and selection of the best tests to aid in situations where the diagnosis or next course of action is still uncertain. Lot’s of things hurt inside of the belly. You don’t need imaging in a child to diagnose pancreatitis – so if the amylase/lipase are abnormally high skip that CT. Also, you should always call the referring physician in any instance where a child has been sent to the ED. Perhapsthe referring provider has only spoken to the family on the phone. It’s quite possible that they said to the mother of a child with a barky cough – “Sounds like croup. The ED might have to give a breathing treatment or get an XRay.” Consider […]

Work as an emergency fellow in Ireland

I posted on this last year but the department I work in as a few upcoming vacancies in July so I thought I would update things for those who might want to come work.

MMUH resus

Are you an emigrated Irish doc in training in Oz or NZ and fancy coming home for 6 months as part of your training? Are you a kiwi or Aussie and fancy some time in Europe as part of your training?* Do you simply want to come and work in a different system and advance your practice. Then these might be the jobs for you. Are you an Irish trainee between basic and advanced training? If you’re working in Ireland and fancy a career development opportunity in one of the big Dublin hospitals then read on. 

[* the Mater is accredited for training in Ireland through the (recently Royal) college of emergency medicine which is the specialist college for emergency medicine in the UK and Ireland. From communication with the Australasian College in Emergency Medicine (ACEM) we have been told that any trainee wishing to undertake training overseas and have that time accredited toward their ACEM training can apply to ACEM prior to beginning the post and obtain prior approval to have the training added toward their ACEM training. So as far as we know we are eligible for training by ACEM too]

The Mater Misericordiae University Hospital (The Mater) in north Dublin is one of the main tertiary centres in the country. It has the national spinal injuries centre and all major specialities apart from neurosurgery and as far as I’m aware it’s the only place doing ECMO in the country. The hospital recently (2013) moved to brand new facilities including a new Emergency Dept, theatres and ICU.

The ED encompasses a large ‘acute floor’ model with acute medicine working out of the same department.  There is a 5 bed resus with CT scanning within the resus bay. There are 2 dedicated ED ultrasound machines.

The hospital serves one of the more deprived areas of Dublin with the obvious result that it sees a fascinating range of pathology from stab wounds, pedestrian trauma to complications of alcohol and  intravenous drug use and all the interesting infectious disease complications that come with it. One of the emergency medicine trainees is a lead for an international HIV screening project in the department.

The ED has created several posts at registrar level to attract new staff and facilitate career development. All posts have protected non clinical time to pursue the appropriate sub specialty. Clinical work will be on the registrar rota in the ED.

Link to official job advert [search for mater misericordiae]

Video ad from Dr Tomas Breslin, Consultant in EM, Mater Hospital

Feel free to contact myself [emergencymedicineireland [at] gmail.com] or Tomas Breslin [tbreslin [at] mater.ie] if interested.

Fellow in imaging

  • 20% protected non clinical time
  • 2 machines in ED
  • Weekly USS teaching (led by fellows)
  • Liaison with emergency radiology (fellowship trained)
  • Echo Module
    • 6 months
    • 2 hrs/wk in ICU with echo tech supervised scanning
    • 1hr/wk with ED/CCU patients with echo tech supervised scanning
    • Formal lectures
    • Examination
  • Early Pregnancy Module
    • based in local maternity hospital
    • this years fellows just starting
  • Suitable for (but not limited to)
    • post basic EM training, able to work clinically as registrar/advanced trainee in ED
    • prior to entry to formal higher training scheme, allows clinical development and level 1 USS skills with space to develop CV prior to application to higher training OR
    • post training as a fellowship to acquire higher level ultrasound skills
    • particularly well suited to UK/Australasian/South African trainees as registration recognised

Education fellow

  • University hospital with huge opportunities for educational development
  • Already happening in ED
    • weekly Registrar/consultant teaching (focused on FCEM exams)
    • weekly SHO teaching (focused on basic approaches to EM)
    • monthly radiology/EM/Acute medicine meeting
    • weekly ultrasound teaching
    • monthly joint EM/ICU meeting
    • Regular student placements as elective students throughout year or 4th year students for weekly placement jan-march
    • Online education induction package for SHOs and student placement
  • 30% protected time for non clinical activities to coordinate and develop education in emergency medicine
  • Suitable for (but not limited to)
    •  post basic training in EM,
    • able to work clinically as registrar/advanced trainee in ED

Conflict of interest statement

  • I work in the ED and really quite enjoy it there but no favours, cash or back rubs were exchanged for this post. I am happy to promote (on the same “no favours, cash or back rubs” terms) other interesting/innovative Irish emergency medicine jobs if people see the need.
  • My opinions are of course my own and do not necessarily represent that of the hospital.

The post Work as an emergency fellow in Ireland appeared first on Emergency Medicine Ireland.

New Method for Creating Flexible Skin Worn Nanosensors (VIDEO)

flexible-nanosensorResearchers at the Technical University of Madrid have developed a cheap new method of manufacturing optical nanosensors that can cling to curved surfaces. The technique may allow for a widespread adoption of skin-worn health monitoring devices that will provide all-day tracking of parameters like body temperature, heart rate, and physical activity.

The technology relies on a combination of aluminum films, the polycarbonate coating used in compact disks, and standard Scotch tape. The aluminum film, only 100 nm thick, has a pattern of holes throughout its surface. The pattern defines how light moving through the film is modulated, revealing the underlying characteristics of the surface below.

Some details about the new sensor technology according to the Madrid team:

These flexible nanosensors enable us to measure refractive index variations of the surrounding medium and this can be used to detect chemical substances.  Besides, they display iridescent colors that can vary according to the viewing and illumination angle, this property facilitates the detection of position variations and surface topography to where they are stuck at a glance.

The creation method for flexible nanosensors consists, firstly, on manufacturing sensors over a compact disc (CDs) of traditional polycarbonate, and secondly, transferring these sensors to adhesive Scotch tapes by a simple stick-and-peel procedure. This way, the nanosensors go from the CD surface to the adhesive tape (flexible substrate).

 
Study in Nanoscale: Compact discs as versatile cost-effective substrates for releasable nanopatterned aluminium films…

Source: Universidad Politécnica de Madrid…

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